Crossover Second Toe: Demographics, Etiology, and Radiographic Assessment

Background: The purpose of this study was to determine the demographics, etiology, and radiographic findings associated with a crossover second toe deformity. Methods: Patients treated operatively for a crossover second toe deformity between 2001 and 2006 were identified. Charts were reviewed for clinical information, and radiographs were examined for pertinent angular measurements. Results: Of 169 patients in the study, 146 (86%) were women. The mean age at surgery was 59 (range 33 to 87) years. The most common complaints of preoperative pain were at the second (156 patients) and first (35 patients) metatarsophalangeal joints (several patients had more than one area of pain). A positive drawer sign was noted in 112 patients. The mean second and third metatarsophalangeal joint angles were −3 degrees and 6 degrees, respectively. There was a significant association of hallux valgus with first metatarsophalangeal joint arthritis ( p < 0.01). The relative length of the second metatarsal averaged 0.2 mm less than the first metatarsal. Conclusions: Crossover second toe deformity had a peak incidence in women over the age of 50 years. There was an increased incidence of both hallux valgus and first metatarsophalangeal joint degenerative arthritis in the patient cohort. A positive drawer sign was a reliable and consistent physical examination finding. The most reliable radiographic indicator of a second crossover toe was medial angular deviation of the second metatarsophalangeal joint in relationship to the third metatarsophalangeal joint angle, although the angle was not necessarily a negative value. There was no correlation between a crossover second toe deformity and second metatarsal length, medial cortex thickness or shaft thickness, the 1–2 intermetatarsal angle, metatarsus adductus, metatarsus primus elevatus, or pes planus.